Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Patient acceptance of patient-controlled intranasal analgesia (PCINA)].
Patient-controlled intravenous analgesia (i.v.-PCA) represents the gold standard in the management of acute postoperative pain. However, in many countries i.v.-PCA is rarely used. Recent clinical studies demonstrated that intranasal fentanyl titration provides a rapid and safe form and pain management. In the present study we investigated patients' acceptance and assessment of patient-controlled intranasal analgesia (PCINA) and compared it to intravenous PCA and the customarily prescribed pain therapy. ⋯ The results demonstrate that the patients' satisfaction with PCINA is comparable to that with i.v.-PCA. Both PCINA and i.v.-PCA were assessed as superior to the customarily prescribed pain management (P = 0.0001). Patients' acceptance of a given form of pain management is mainly related to its efficiency. However, side effects such as pain on injection with i.v.-PCA, or frequent opioid administration with PCINA, must be considered when assessing a method of pain control. Patients' global assessment includes both efficiency and side effects. PCINA represents an interesting alternative non-invasive method for postoperative pain management.
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Randomized Controlled Trial Clinical Trial
[Transdermal scopolamine for prevention of postoperative nausea and vomiting. No clinically relevant result in spite of reduced postoperative vomiting in general surgical and gynecologic patients].
In a prospective double-blind trial, transdermal scopolamine (TS) was compared to placebo (P) in the prevention of postoperative nausea and vomiting (PONV) within a 48-h interval. After stratification for gender and surgical procedure, patients were randomly chosen to receive either TS or placebo. ⋯ The routine administration of TS for gynaecological and surgical patients cannot be recommended because of the lack of effect on postoperative nausea and only marginal benefit concerning postoperative vomiting.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Hemodynamic effects of three different dosages of the induction hypnotic, eltanolone, in coronary surgery patients].
Eltanolone is a new steroid anaesthetic agent that is 5-beta reduced derivative of progesterone. In the present study we investigated the haemodynamic effects of eltanolone or thiopentone in patients scheduled for coronary artery bypass grafting. ⋯ Mean arterial pressure reduction induced by eltanolone is most likely the result of the combination of a decrease in cardiac contractility and peripheral vasodilatation. In contrast, mean arterial pressure reduction in the case of thiopentone seems to be exclusively related to the negative inotropic properties of the drug. Results of a dosage finding study [5] with eltanolone revealed an AD50 of 0.33 mg/kg. In our study 0.5 mg/kg eltanolone brought all the patients to sleep within 2 minutes. The haemodynamic results do not show any significant difference up to twofold dosage. Therefore, the therapeutic margin seems to be large. Because of considerable interindividual variability additional studies in larger collectives are required for definitive evaluation of the drug.
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Randomized Controlled Trial Clinical Trial
[10 years of spinal anesthesia in infants and children for orthopedic surgery. Our clinical experience].
Over a period of 10 years various orthopaedic-paediatric operations were performed under hyperbaric spinal anaesthesia. ⋯ The duration of spinal anaesthesia in infants is shorter than in adult patients. Spinal anaesthesia is a suitable anaesthetic technique for paediatric surgery. This method of anaesthesia may avoid the increased incidence of postoperative respiratory complications associated with general anaesthesia. Special anatomical and pharmacological considerations for infants under 1 year of age include the fact that the spinal cord may end as low as L3 in the neonate. Our results show that spinal anaesthesia can be safely and reliably performed in these infants. Hyperbaric bupivacaine 0.5% as a spinal anaesthetic agent in infants has been investigated extensively and produces consistently good operating conditions. The technique has not resulted in hypotension or bradycardia, and no complications have occurred. We did not use atropine in any patient. However, the superiority of spinal anaesthesia over other forms of anaesthesia in this group of patients remains to be demonstrated. Continuous training and critical analysis are needed for good results.
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Clinical Trial Controlled Clinical Trial
[Intraoperative contrast echocardiography for detection of a patient foramen ovale using a provocation test and ventilation with PEEP respiration].
Intraoperative paradoxical air embolism may occur even if a patent foramen ovale (PFO) is excluded by contrast transoesophageal echocardiography (TEE) under 20 cm H2O positive airway pressure. It is questionable whether the combination of PEEP and ventilation with a large tidal volume increases the sensitivity of contrast TEE in detecting a PFO. ⋯ The use of provocation manoeuvres including ventilation with PEEP and high tidal volumes might improve the ability to detect a PFO presenting with right-to-left interatrial shunt by intraoperative contrast TEE, but does not have 100% sensitivity. However, our results clearly indicate that ventilation with PEEP and high tidal volumes may predispose to paradoxical embolism.